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1041209

registered interest
date	14/01/2019
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	University Hospitals Bristol NHS Foundation Trust: Liothyronine
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what action they plan to take to lift the ban on the prescription of liothyronine (T3) by University Hospital Bristol in contradiction of the advice given by NHS England.
tabling member printed	Lord Hunt of Kings Heath
uin	HL12791
answer	answer is ministerial correction date of answer 22/01/2019 answer text <p>NHS England is working closely with clinical commissioning groups (CCGs) on the prescribing of liothyronine to support them with the implementation of guidance for CCGs on items which should not be routinely prescribed in primary care. The Department has not had specific discussions with NHS England or made an assessment on these issues.</p><p>CCGs are expected to have regard to national guidance, and are responsible for developing their own local approaches to its implementation taking into account local priorities and needs. CCGs set the policy which governs what hospitals and trusts implement, therefore the prescription of liothyronine at University Hospital Bristol and Musgrove Park Hospital in Taunton is a matter for those CCGs.</p><p>This guidance for CCGs on items which should not be routinely prescribed in primary care includes recommendations on the use of liothyronine in line with the British Thyroid Association, who advise that a small proportion of patients treated with levothyroxine continue to suffer with symptoms despite adequate biochemical correction. In these circumstances,</p><p>where levothyroxine has failed and in line with this guidance, endocrinologists providing NHS services may recommend liothyronine for individual patients after a carefully audited trial of at least three months duration of the drug.</p><p>Further guidance on the prescribing of liothyronine has been published by the Regional Medicines Optimisation Committee. The aim of the guidance is to make best practice on the prescribing of liothyronine clearer. A copy of <em>Guidance – Prescribing of Liothyronine</em> is attached.</p> answering member printed Baroness Manzoor grouped question UIN HL12792 HL12793 HL12794 question first answered 22/01/2019 16:17:24 answering member 4289 label Biography information for Baroness Manzoor attachment 1 file name RMOC-Liothyronine-Guidance-v2.0-final-1.pdf title RMOC liothyronine guidance
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1038905

registered interest
date	10/01/2019
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Neural Tube Defects
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government how many babies have been born in England with neural tube defects, such as spina bifida, in the last five years for which figures are available.
tabling member printed	Baroness Corston
uin	HL12742
answer	answer is ministerial correction date of answer 22/01/2019 answer text <p>Public Health England contributes to the European Surveillance of Congenital Anomalies (EUROCAT), which reports on congenital anomaly statistics by country.</p><p>The numbers of babies born with neural tube defects from 2012 to 2016 are displayed in the attached table, due to the size of the data. Data for 2017 and 2018 are not currently available. Validated data for 2017 will be available from April 2019.</p> answering member printed Baroness Manzoor question first answered 22/01/2019 16:13:47 answering member 4289 label Biography information for Baroness Manzoor attachment 1 file name HL12742 table formatted.docx title HL12742 table formatted
tabling member	215 label Biography information for Baroness Corston

1038911

registered interest
date	10/01/2019
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Food: Imports
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government how many additional food inspectors will be put in place to ensure food imports from the EU are checked at transit ports in the event of a no-deal Brexit.
tabling member printed	Baroness Jones of Whitchurch
uin	HL12748
answer	answer is ministerial correction date of answer 23/01/2019 answer text <p>In the event of a ‘no deal’ European Union exit, there will be no additional controls on food and feed originating from the EU. However, third country high-risk food and feed consignments transiting the EU destined for the United Kingdom will be subject to controls and will need to enter the UK at ports with the required facilities to undertake those controls. Following detailed analysis to determine the possible number of such transits, there is sufficient existing capacity at UK ports with those facilities to undertake all relevant import controls.</p> answering member printed Baroness Manzoor question first answered 23/01/2019 11:50:51 answering member 4289 label Biography information for Baroness Manzoor
tabling member	3792 label Biography information for Baroness Jones of Whitchurch

1038929

registered interest
date	10/01/2019
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Health Services: Travellers
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government, following the commitment to address health inequalities in the NHS Long Term Plan, published on 10 January, what steps they intend to take to tackle the health inequalities experienced by members of the Gypsy, Roma and Traveller communities.
tabling member printed	Baroness Whitaker
uin	HL12766
answer	answer is ministerial correction date of answer 23/01/2019 answer text <p>During 2019 all local health systems will be expected to set out how they will reduce health inequalities by 2023/24 and 2028/29 including, where applicable, for Gypsy, Roma and Traveller (GRT) communities.</p><p>We are reviewing the collection of data within the National Health Service and working closely with NHS England to complete a scoping exercise to understand how information on protected characteristics is gathered in existing NHS datasets. The Department plans to complete an initial assessment later this year, which will form the basis for future decision-making on NHS data collection by ethnicity.</p><p>NHS England has produced guidance for general practices clarifying rights of patients and responsibilities of providers in registering with a general practitioner. It also co-produced a leaflet for members of the GRT communities on how to register. These will be kept under review.</p><p>The Department of Health and Social Care is also working closely with the Ministry for Housing, Communities and Local Government and the Department for Education on six community-led pilot projects, two of which are looking to improve health outcomes for GRT communities.</p><p>The Government commissioned research from the universities of Dundee and York examining how trust in healthcare services could be enhanced amongst Gypsy, Roma and Traveller communities. The report, <em>Enhancing Gypsy, Roma and Traveller peoples’ trust: using maternity and early years’ health services and dental health services as exemplars of mainstream service provision</em>, was published in September 2018. It has made eight key recommendations to the health sector and other key providers, which include increasing collaborative working with those that already have trusted relationships with GRT communities e.g. individuals from third sector organisations, individual health or other sector professionals; and suggested the introduction of literacy help-cards throughout the NHS. These are cards that can be presented to front line staff or receptionists to ask for discreet help with form-filling. A copy of the report is attached.</p> answering member printed Baroness Manzoor question first answered 23/01/2019 11:52:52 answering member 4289 label Biography information for Baroness Manzoor attachment 1 file name Report_on_GRT_health.pdf title Report_on_GRT_health.pdf
tabling member	2510 label Biography information for Baroness Whitaker

1038750

registered interest
date	09/01/2019
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Tattooing
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government how many tattoos have been removed at a cost to the NHS in England; and what is the total cost of such removals since 2009.
tabling member printed	Lord Palmer
uin	HL12716
answer	answer is ministerial correction date of answer 22/01/2019 answer text <p>It is possible that tattoo removal procedures could be classified to a number of ‘skin excision’ codes within the OPCS-4 Classification. These procedures codes would be assigned for any type of skin excisions, for example, the removal of benign and malignant neoplasm. It is not possible to separately identify data specific to tattoo removal procedures.</p> answering member printed Baroness Manzoor question first answered 22/01/2019 16:14:12 answering member 4289 label Biography information for Baroness Manzoor
tabling member	3192 label Biography information for Lord Palmer

1037592

registered interest
date	08/01/2019
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Hospitals: Nurses
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government whether there is a legal limit on the ratio of nurses to patients on wards in NHS hospitals in England; and if so, what are those limits.
tabling member printed	Lord Clark of Windermere
uin	HL12650
answer	answer is ministerial correction date of answer 22/01/2019 answer text <p>The National Health Service does not have a legal ratio of nurses to patients.</p><p>Appropriate staffing levels are the responsibility of commissioners and trusts. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 include a requirement for the deployment of sufficient numbers of suitably qualified, competent, skilled and experienced persons at all times.</p> answering member printed Baroness Manzoor question first answered 22/01/2019 16:02:02 answering member 4289 label Biography information for Baroness Manzoor
tabling member	525 label Biography information for Lord Clark of Windermere

1037602

registered interest
date	08/01/2019
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Allergies: Medical Treatments
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government how many adrenaline auto-injectors they estimate will be needed over the next 12 months to ensure that no patient dies as a result of lacking such a device.
tabling member printed	Baroness Finlay of Llandaff
uin	HL12658
answer	answer is ministerial correction date of answer 22/01/2019 answer text <p>Based on available data sources (IMS, company supplied figures and NHS Prescription Cost Analysis Data), we estimate that approximately 900,000 adrenaline auto-injectors were issued throughout 2017 across the United Kingdom. Analysis of year on year data suggests an upward trend in the number of devices supplied, so the required volume is likely to exceed 900,000 in 2019.</p> answering member printed Baroness Manzoor question first answered 22/01/2019 16:01:04 answering member 4289 label Biography information for Baroness Manzoor
tabling member	3609 label Biography information for Baroness Finlay of Llandaff

1037603

registered interest
date	08/01/2019
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Neurology
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what plans they have to improve services for people with neurological conditions such as Parkinson’s.
tabling member printed	Baroness Gale
uin	HL12659
answer	answer is ministerial correction date of answer 22/01/2019 answer text <p>NHS England established the National Neurology Advisory Group (NNAG) with the Neurological Alliance which led the development of a national collaborative clinical leadership model, bringing together key stakeholders such as Parkinson’s UK, a range of national clinical leaders and patient groups with the aim to seek alignment between programmes in NHS England, arm’s length bodies and system partners and to guide the strategic development of work to improve outcomes for people living with neurological conditions including Parkinson’s.</p><p>Throughout 2018, the NNAG has organised a number of condition specific meetings with the aim of defining what good neurology looks like for patients with neurological conditions including Parkinson’s, and identifying the barriers to achieving that.</p><p>NHS England also supports local transformation through their national programmes, as highlighted in the NHS Long Term Plan. NHS RightCare has published a number of intelligence tools and resources to support reduction in unwarranted variation in neurology services. For 2018/19, 37 of 195 clinical commissioning groups submitted delivery plans that include neurological problems as improvement projects as part of their NHS RightCare programmes. Of these 37, six systems have explicitly referenced Parkinson’s in their delivery plans. Interventions in these plans primarily focus on ensuring that patients are linked into end of life care recording and reviewing effective primary prescribing of Parkinson’s disease drugs.</p><p>NHS England Specialised Commissioning has also recently approved a national review of specialised adult neuroscience services, working alongside and closely with the Getting It Right First Time programme.</p> answering member printed Baroness Manzoor question first answered 22/01/2019 16:06:58 answering member 4289 label Biography information for Baroness Manzoor
tabling member	2503 label Biography information for Baroness Gale

1037606

registered interest
date	08/01/2019
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Health Services: Foreign Nationals
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government how many written submissions they have received as part of the review of the National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017; how many case studies were submitted to the review where urgent care was withheld; and what assessment they have made of the number of case studies submitted where urgent care was, or may have, been incorrectly withheld.
tabling member printed	Lord Hunt of Kings Heath
uin	HL12662
answer	answer is ministerial correction date of answer 22/01/2019 answer text <p>The Department engaged with 79 organisations as part of the process of reviewing of the National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017 and received 57 formal responses. Of these, 22 case studies included instances where individuals were required to make advance payment for treatment that the Department has concluded was arguably, on proper analysis, immediately necessary and/or urgent.</p><p>The common issue in these cases is that clinicians have not fully taken into account the date at which those seeking treatment have been expected to leave the United Kingdom, something that national guidance is clear must be taken into consideration when making a decision as to whether or not treatment is considered urgent. To mitigate this risk and help ensure the regulations are applied as intended the Department has updated its guidance, published on 24 December 2018, and is planning further updates to relevant training material and case studies in early 2019 to ensure all relevant circumstances are considered when deciding if a treatment is to be considered immediately necessary, urgent or non-urgent.</p> answering member printed Baroness Manzoor question first answered 22/01/2019 16:03:35 answering member 4289 label Biography information for Baroness Manzoor
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1037618

registered interest
date	08/01/2019
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Nurses: Apprentices
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what steps they are taking to increase the number of apprentices training to become registered graduate nurses.
tabling member printed	Baroness Redfern
uin	HL12672
answer	answer is ministerial correction date of answer 22/01/2019 answer text <p>The Department is fully committed to increasing the number of nursing apprenticeships. In support of this, we have developed a complete apprentice pathway from entry level nursing associate to postgraduate advanced clinical practice in nursing. This will support people from all backgrounds to enter a nursing career in the National Health Service.</p><p>In the 2017/18 academic year, there have been 300 apprenticeship starts recorded for the standard ‘registered nurse’ and 1,420 apprenticeship starts recorded for the standard ‘nursing associate’.</p><p>We are working closely with employers and Health Education England to make sure that the NHS is fully supported to recruit apprentices, both in nursing and in a range of other occupations and in doing so ensure the NHS has a workforce that is reflective of the population it serves.</p> answering member printed Baroness Manzoor question first answered 22/01/2019 16:02:39 answering member 4289 label Biography information for Baroness Manzoor
tabling member	4551 label Biography information for Baroness Redfern